Study identifies link between endophthalmitis, coronavirus

According to a release by the American Academy of Ophthalmology, in just two months, three patients at New York’s Northwell Health hospital were diagnosed with keratitis that quickly led to endophthalmitis and vision loss.

In one patient, the disease was so severe that an eye had to be removed. All three of the patients tested positive for COVID-19.

Results of the retrospective study were released at the AAO’s 2020 virtual annual meeting. Investigators said they hoped their findings would encourage the medical community to consider the eye when evaluating the role of anti-infectious treatment and immunomodulation.

Related: COVID-19: Groups urge healthcare workers to get vaccinated

Investigators noted that while the evidence does not show that the virus caused the devastating eye infections, the occurrence of keratitis leading to rapid perforation and endophthalmitis is exceedingly rare.

Moreover, with three cases present in the span of two months in New York, which has been a COVID-19 epicenter, more study was warranted, according to investigators.

According to Amilia Schrier, MD, a professor of ophthalmology at the Zucker School of Medicine at Hofstra University in Hempstead, New York, the three patients, all in their 60s, and from Manhattan, Brooklyn, and Long Island, presented to the Northwell Health Ophthalmology Department within a two-month period. Two were outpatients and one was in the hospital at the time of keratitis diagnosis. Each of the patients tested positive for COVID-19.

According to Schrier, each patient had a different different organism on culture, including Streptococcus pneumoniae, Serratia marcescens, and Candida parapsilosis.

While investigators could not say for sure that COVID-19 caused the endophthalmitis, it also could not be ruled out. She also noted in the release that it is unusual for keratitis to progress to endophthalmitis.

“A 2012 study reported only 27 out of 9,934 eyes in a 15-year period experienced endophthalmitis caused by keratitis,” she said.¹

Related: Eliminating risk of endophthalmitis during intravitreal injections for patients wearing masks

Schrier also pointed out in the statement that three of these cases in a two-month period with COVID-19 positivity suggests that there may be an association between COVID-19 infection and severe eye disease.

Sonal S. Tuli, MD, a clinical spokesperson for the AAO who was not involved in the study, urged caution in interpreting the results while that while these findings do require further research.

“The findings do not suggest that COVID-19 causes endophthalmitis but that there is some relationship between the two,” she said in a statement.

Dr. Tuli explained that there could have been some other underlying health issue in each of the patients that made them more liable to contract COVID-19 as well as a severe infection in their eye. Those health issues could include a compromised immune system or nutritional deficiencies. 

“It is also possible that these findings are incidental because of the large numbers of COVID-positive patients presenting to New York hospitals during the peak of the pandemic in New York,” she concluded.

In a separate study, investigators from Tel Aviv, Israel, cautioned recently that patients who wear face masks during the administration of intravitreal injections could be at a higher risk for the development of endophthalmitis.

Related: The eyes offer conjunctival clue to COVID-19

To date, the only other eye condition linked to COVID-19 has been conjunctivitis.

In June, a team of investigators at the University of Alberta reported that a case of pink eye was being considered as a reason to be tested for COVID-19.

While coughing, fever and difficulty breathing are common symptoms of the illness, a recent case study involving an Edmonton woman and published in the Canadian Journal of Ophthalmology determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms.

Reference

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490005/